Medicaid in Georgia is in trouble and cuts being proposed range from removing dental and podiatry services for adults to reducing eligibility for the benefits for the aged, blind and disabled.
A week ago, Thomaston native Tim Burgess, who is the director of the Georgia Department of Community Health, spoke to members of the Thomaston-Upson Chamber of Commerce at a business breakfast here. He told the hometown gathering that a major overhaul of Medicaid was on the horizon.
Burgess told area business leaders that children are the major beneficiaries of Medicaid, followed by disabled adults and the elderly.
"We're dealing with real people," Burgess said, "people who really do need help. But the expense of it is becoming unsustainable."
Just a week later, in his official capacity as director of community health, Burgess said $172 million to $327 million must be cut from Medicaid in order to be fiscally in line with Gov. Sonny Perdue's budget guidelines.
A round of Medicaid cuts was just implemented July 1 which removed 32,000 children from the program's coverage.
Burgess said there are four basic drivers for the growth of Medicaid:
1) The price paid to hospitals, nursing homes and doctors.
2) Scope of services - Is it too rich? Not rich enough?
3) Eligibility - How do recipients become eligible?
4) Utilization - How much of the services are used by people?
The first three would involve cuts - cuts on money paid to hospitals, cuts in the services are
covered by Medicaid and a tightening of eligibility requirements aimed at removing people from the rolls.
"It's the last one that may be our best chance to bring costs into control," Burgess said. He said his department has been talking with Gov. Perdue and the legislators about a new model for Medicaid.
Burgess said if a model could be put in place to better control utilization, it might be the best way to restore viability without taking draconian measures.
One way proposed to control utilization of Medicaid services is to move a sizable number of low-income Medicaid enrollees to an HMO-like organization.
Burgess inherited the Medicaid problems when he took over the Department of Community Health. He has worked during the past 12 months to bring the payment and claim systems back on line. That's been an issue of concern to local physicians, such as those with Thomaston OB-Gyn, a practice which serves a disproportionately large number of Medicaid enrollees. Last year, payments from Medicaid to the local practice fell tens of thousands dollars behind, threatening to jeopardize the services the practice could provide to patients.
Medicaid is the second largest expenditure in state government, with education being the top expense. Burgess said the money the state puts into Medicaid shows the importance of providing healthcare to those who may not otherwise afford it.
"The problem is that it is an entitlement program, and it is beginning to grow out of control," he said.
He said the state's total revenue is projected to grow at a rate of six percent, while Medicaid expenditures are increasing by 10 percent to 12 percent each year. One in six Georgians has healthcare through Medicaid and 86 percent of nursing home patients are covered by Medicaid.
Burgess spoke what he has learned since taking over the Department of Community Health: